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FOR OFFICE USE: <br /> --------------- - ------------ --------- -- ---------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------ -- -------------------- ------ (Complete-in Duplicate) <br /> Date Issued <br /> -------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 49. <br /> ` JOB ADDRESS ASND] LOCATIION----------11- �...--- --^---------- <br /> Owner's Na e {r�� - ?- = �� r � - ....I---------------- -------------- <br /> Phone <br /> Address�r. a : �'tr4 ...�� ' ------------- ------- ------------------------ -•----------------------------------- -----------------------.._...-------------- <br /> Contractor's Name---- <br /> -_-.-- F-----!____---- -, ------ -------------------------------- <br /> Installation <br /> ------ <br /> Apar <br /> ment House <br /> InstaliatNumbel ofrlivingRunildence Numbertof bedrooms ____-_CNumberlof bath Trailer41ou rt ❑ Motel ❑ Other ❑ <br /> Gize ,/fife <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _!3_ ft <br /> Character of soil to o depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'vj� Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ NoEr FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T <br /> e tic Tank: Distance .from nearest well_________________Distance from foundation____._._.____._____.Mater;al __...._.______._..__._____.______.....____.-__ <br /> t , No. of compartments--------------------------Size-------------=------ -------- Liquid depth--------- ------- --------Capacity----------------------- <br /> DisposaT`Field: Distance from nearest well-----------------Distance from'foundation--------------------Distance to nearest lot Line________._____... <br /> ❑ Number of lines.----------------------------------Length of each line--.--------------------------.Width of trench-------------------------------.--- \ <br /> Type of filter material----------......._..-_--Depth of filter material----.-------------------Total length_"-------__-____________________--__ <br /> �- <br /> /� 7 S____�__ Distance to nearest lot line__.��__ ___._._ <br /> 5eepage Pit: Distance to nearest weEl/!./ Distant "o_m�foundation____ __.__ //1 <br /> Number of pits-__ _____________Lining mater;a _C)�. -% Size: D;ameter._l�_._ ------------Depth..... �___..___.__.._ <br /> cesspool: Distance from nearest well ----------------Distance from foundation... ............. ..Lining material--------------------_' <br /> ❑ Size. Diameter- -- ---- -- -- ------Depth------ ----- - -- ---------------------------------Liquid Capacity +f----------------------gals. <br /> Privy: Distance from nearest well-------------------------- _--- _________________Distance from nearest building-----------------------------------__.._. <br /> ❑ Distance to nearest lot line --------- ---- ------------------------- ------ ------------------------------------- ----------------- :----------------------------- <br /> Remodeling and/or repairing (describe)=------- - -------------------- ---------- ------------------------------------------------------ . .------------------------------------------------ <br /> -----------­----------------__1------------------------ <br /> --------------------------'--------------------------------------------------------------------------------------------- •------------------------------------------------------------------------------------------------------- ------------- ---- --------------- <br /> ------------------------•----------------------------------------- --------------------------------------------------=_---=----------------------------------- - 4 <br /> I -----------------------------------------------------------------------------------------------------------------------------------------------------------I---- --------------- ------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances to laws, an�rules d 'ulations of the San Ja quin.Local Health District.# ' <br /> _. <br /> i <br /> (Signed] • ---------- - - - - (O�Zvner and/or Contractor <br /> --- ---C <br /> By:---------------------- -----•-------------- -------------------- �► .- .! = ----(TitleGl' - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buil"Ing , etc., can bed on reverse side). . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.---r - ( ; a ----------------------------------- DATE..... ----------- <br /> REVIEWEDBY--------------------------------------------- ------------- ---------------------------------------------------------- DATE--------------- -------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -------------------------------------------------- ------------- --­­--------------------- DATE-- ------ - ----------- - <br /> Alterations and/or recommendations:__..---Yj?-_e.ltl.....__ GL- 11__-l+ ----------- : P-- - ------------d?-1-.- ------------------------ <br /> 2d :-r'--------------- <br /> e ' ---------------------------------- <br /> ------------------ <br /> --------------------------'__..----------------- +- l /....... ---- -------------- .............................. ------- ------------'------------------------------- ........ ---------------- <br /> ! -------------------- - --------- ................... --- -- ----- ----­­......... ---------------------------------------------------- -------------------- ---------------- ----------- ------ <br /> FINAL INSPECTION BY:. e .1.l�� /.41Z X.d--..__ Date- 3 C.-"[J Q------. ---- -----•-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi..California ay. Manteca,California Tracy, California <br /> E,H.9 2M 1-67 Vanguard Press <br /> t <br />